Back Problem Rating

Back Problem Rating

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Posts: 219

Jul 18 11 11:02 PM

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Greetings

I just receive my results froma two year claim for a list of problems that were denied or remained the same. I need help understanding how the C&P examiner came up with these measurements and without using a goniometer, and which one should be used.

"C&P examiner noted forward flexion of the thoracolumbar spine was 70 of 90 degrees (normal 0 to 90 degrees), with pain noted at 60 degrees; extension was 10 of 30 degrees (normal 0 to 30 degrees), with pain noted at 5 degrees; left and right lateral flexion was 15 of 30 degrees (normal 0 to 30 degrees), with pain noted at 10 degrees; and, left and right lateral rotation was 30 of 30 degrees, for a combined range of motion of 170 degrees."

"C&P examiner noted positive tenderness of bilateral paravertebral muscles.Negative left straight leg raise and negative right leg raise; forward flexion of the thoracolumbar spine was 0 to 45 degrees with discomfort; extension 0 to 15 degrees with discomfort; left and right lateral flexion was 0 to 10 degrees with discomfort, and left and right lateral rotation was 0 to 27 degrees with discomfort. These are initially and with repetition and they are limited because of pain."

It's hard to say because the entire examination isn't posted to review, but based on what is posted, if I were the rater I would return the exam for clarification of the range of motion measurements, more specifically the forward flexion, and ask the examiner to include the range of motion measurements after three additional movements based on the Deluca criteria and new VA examination guidelines.

This ROM report is one of three that was done by VA examiners for this claim but this one had the highest ROM values. The other two ROM reports had much lower values but the RO chose to use the one I mentioned in my earlier post...can they do that. The lowest of the three reported a forward flexion of the thoracolumbar spine was 0 of 45 degrees:

"The VA examiner noted positive tenderness of bilateral paravertebral muscles.Negative left straight leg raise and negative right leg raise; forward flexion of the thoracolumbar spine was 0 to 45 degrees with discomfort; extension 0 to 15 degrees with discomfort; left and right lateral flexion was 0 to 10 degrees with discomfort, and left and right lateral rotation was 0 to 30 degrees with discomfort."

They are supposed to look at all the evidence and make a determination. The benefit of the doubt is supposed to go to the veteran when there is contradictory evidence. Also, they are stating that your rang of motion is within certain ranges but from the looks of it you have major pain issues in general. The range of motion portion is also supposed to be based upon when the pain starts. If you move slightly forward or backwards and are experiencing pain that should be your range of motion.

"The Rough Rider"... "Far Better It Is To Dare Mighty Things..... Than
To Take Rank With Those Poor Timid Spirits Who Know Neither Victory Or
Defeat." Theodore Roosevelt 1899

I know back injuries are primarily based on ROM but I had no idea about the 3 repetitions when I went for my C&P Exam. The doctors exam notes states a slight reduction in ROM (forgot the exact numbers and write up) but it was enough to get me 10% for back. But I had pain noted in the exam has having back pain throughout my entire ROM. I was miserable and almost fell over twice. The doctor even cracked a joke when I reached to grab the sink to help me get back up. I somehow forced my way through the 3 repetitions and was in total pain. All this is for nothing since it "doesn't limit" my ROM supposedly. The Deluca thing has really limited back pain and back injuries. I was at my limit during the exam and was thinking the doctors needed to see me perform that ROM for some doctor reason, but not a VA policy reason. Now I'm stuck with a painful back that I have to take narcotics for 24/7 and I'm at 10%. Yet, in other VA notes that you can find things that say that a part that is painful on use must be considered seriously disabled, yet my back is painful on use but I don't think 10% is compensating for a seriously disabled body part.

Also, the RO did mention the Tents Unit that I'm using and steriod shots that I've taken but only mentioned one (Lyrica) of the four types of pain killer meds (Gabapentin, Tramadol, Amitriptyline Hydrochloride) that I was taken in my rating decision. Without the pain meds, Tents Unit and steriod shots, I honestly believe my ROM would be much worst.

I`am still active duty and had a 3 level fusion done and was told I would only get 40 percent for my back because of my lack of ROM. It is not a fair way for us, but it i what it is. Back problems have always been rated low from what I have read. Good luck man.....